Conscientious objection in the Maltese pharmacy community

Abstract

The last half of the twentieth century has seen the concept of conscientious objection move from the military context into other areas, notably becoming a permanent fixture in the medical landscape. The pharmaceutical service could not remain a spectator and remain silent as new technologies challenged important ideological, moral and religious convictions. Pharmacists in USA and Europe refused to dispense medicines that violated their conscience. This issue of conscientious objection arises because some pharmacists and clients have a plurality of competing conceptions of the good. The narratives that have evolved around conscientious objection have generally created tensions between the pharmacist who refuses to dispense certain medications that are perceived to violate one's conscience and the client who wants his/her legal prescription to be filled. Both sides invoke principles of human dignity, human rights, autonomy, human flourishing and tolerance in their discourse to strengthen their arguments. Some commentators have advanced positions that diminish the moral space of the pharmacist to zero; others suggest that the pharmacist must be free to define the scope of their professional obligations using their conscientious judgements. This dissertation hypothesizes a system that can potentially reduce the tension between these two extreme positions. General ethical theories and the internal morality of pharmacy give support to this compromise system that tries to find a delicate balance between the conscious absolutism view (full pharmacist's moral space) and the incompatibility thesis (zero pharmacist's moral space). This system recognizes the right of the pharmacist to refuse certain medicines that violate his/her moral integrity but this right is not absolute. There are certain ethical constraints that limit the exercise of conscience. This type of compromise system increases transparency and improves the pharmacist-client relationship. This type of system encourages a level of diversity in pharmaceutical care that would mirror the level found in society as a whole. This system has the potential to make the running of the pharmaceutical care run smoother in a pluralistic society. This compromise system is more sustainable and open to changing attitudes from future generations yet to join the debate of conscientious objection in the pharmaceutical care. In Malta, this debate has not yet started. The Maltese law offers no legal protection to the pharmacist who refuses to dispense certain medications while the Maltese code of pharmaceutical care offers the same pharmacist a very broad moral space. Sooner than later, the Maltese pharmacist has to join this debate of conscientious objection especially as more controversial issues, such as emergency contraception, enter the Maltese arena.